A medical assistant-based program to promote healthy behaviors in primary care

Abstract

Purpose: Most primary care patients have at least 1 major behavioral risk: smoking, risky drinking, low physical activity, or unhealthy diet. We studied the effectiveness of a medical assistant-based program to identify and refer patients with risk behaviors to appropriate interventions.

Methods: We undertook a randomized control trial in a practice-based research network. The trial included 864 adult patients from 6 primary care practices. Medical assistants screened patients for 4 risk behaviors and applied behavior-specific algorithms to link patients with interventions. Primary outcomes were improved risk behaviors on standardized assessments. Secondary outcomes included participation in a behavioral intervention and the program's effect on the medical assistants' workflow and job satisfaction.

Results: Follow-up data were available for 55% of participants at a mean of 12 months. The medical assistant referral arm referred a greater proportion of patients than did usual care (67.4 vs 21.8%; P <.001) but did not achieve a higher success rate for improved behavioral outcomes (21.7 vs 16.9%; P=0.19). Qualitative interviews found both individual medical assistant and organizational effects on program adoption.

Conclusion: Engaging more primary care team members to address risk behaviors improved referral rates. More extensive medical assistant training, changes in practice culture, and sustained behavioral interventions will be necessary to improve risk behavior outcomes.

Figure 1.

Algorithm for medical assistants’ risk behavior assessment and management. Note: After the health risk assessment, the medical assistant and patient discuss type of referral for smoking, low physical activity, and unhealthy diet. For risky drinking, the medical assistant informs the patient’s clinician and the clinician assesses the need for referral program. F=female; LCDC=substance abuse clinic; M=male; SALSA=low-impact aerobics, dancing class; SAMHD=San Antonio Metropolitan Health District; Walk San Antonio = community-based walking program at multiple sites.

Figure 2.

Patient flow diagram for randomized trial. No. with behavior = number of patients with a specified behavioral risk factor. Patients with multiple risk behaviors are counted in more than 1 category. No. choosing = number of patients who chose a specified risk factor as their priority for intervention. Patients could be counted in only 1 category. N/A = patients in the control arm did not choose a priority risk factor for intervention. No. with data at follow-up = number of patients who responded to follow-up questionnaire and who had complete data at baseline and follow-up for the specified risk factor. Intervention patients were counted only in 1 category. Control patients were counted in each category in which they had the specified risk.